Veteran with PTSD who killed family repeatedly relapsed if stressed, inquiry hears

The military psychiatrist who diagnosed Lionel Desmond with complex post-traumatic stress disorder told a fatality inquiry that despite some improvement after three years of treatment, the Afghanistan veteran continued to relapse when triggered by the stressors in his life.

Dr. Vinod Joshi's testimony Tuesday marked the first time the inquiry into Desmond's fatal shooting of his wife, daughter, mother and himself in 2017 heard exactly what treatment the corporal got within the military health-care system. 

Joshi met with Lionel Desmond in 2011, four years after the soldier returned from what's been described by his brother in arms as a particularly brutal tour in Afghanistan. 

In his psychological assessment, Joshi found Desmond showed clear symptoms of PTSD: he had nightmares and flashbacks about the bodies, he said he often felt numb, and he could not connect with his family and friends. 

Joshi and the mental health team at Canadian Forces Base Gagetown in New Brunswick created a treatment plan for Desmond that combined medication, group therapy and individual psychotherapy.

CBC reporter Laura Fraser was live blogging the hearing:

'Not fully recovering'

The psychiatrist said he saw Desmond about once a month, while the psychologist saw him weekly. By the end of 2012, Joshi said Desmond had finished his trauma-informed therapy and reported fewer nightmares, better sleep, and that he was taking on more responsibility at work. 

But then Desmond suffered repeated relapses.

By 2014, it became clear that Desmond "was not fully recovering and stressors of life were causing setbacks on a regular basis," Joshi told the inquiry. 

PTSD is usually connected to a single traumatic event, whereas complex PTSD — which is what Desmond experienced — develops from repeated exposure to trauma.

Joshi testified it's not unusual for a patient's PTSD symptoms to fluctuate in intensity, and that while the goal for recovery is to return to as close to pre-PTSD life as possible, it's not always realistic. 

The inquiry heard there were several major sources of stress in Desmond's life outside of his diagnosis. 

He reported experiencing racism in the military, his father was diagnosed with multiple sclerosis, and Desmond and his wife continued to have conflict in their marriage. Joshi said the conflict was an "undercurrent" throughout Desmond's treatment that was exacerbated by PTSD and their separation, with Desmond in Oromocto, N.B., and Shanna in Antigonish, N.S., studying for her nursing degree. 

Joshi said the marital difficulties had a negative impact on Desmond's recovery.

"His long-term prognosis is guarded in light of poor response to treatment," Joshi wrote in a psychological progress report in October 2012. 

But he said Desmond never showed any signs he would become violent. 

The lawyer representing Desmond's in-laws questioned that judgment, noting Desmond turned his gun over to a friend after he was the target of a racist comment and felt himself becoming very angry.

Joshi responded, however, that he felt Desmond showed control by choosing to give up his weapon. 

Getting a firearms licence

In fact, although Joshi said it was becoming clear Desmond would not likely return to his duties as a soldier, the psychiatrist signed off on a firearms review in November 2014 that would grant Desmond his gun licence. Another doctor, Paul Smith, would do the same in 2016.

When Joshi was questioned about the decision, he said Desmond was stable and had indicated he wanted to go hunting with friends. Joshi said the fact that Desmond was seeking social connection was positive and a protective factor against the damaging effects of his illness.

Desmond shot his wife, Shanna; his 10-year-old daughter, Aaliyah; his mother, Brenda; and then himself after bursting into a home in Upper Big Tracadie, N.S., on Jan. 3, 2017.

The psychologist who treated Desmond alongside Joshi is expected to testify at the inquiry Wednesday morning.